Morning Briefing
Summaries of health policy coverage from major news organizations
Push Toward More Automation At The VA Has Brought More Errors On Veterans’ Claims, Employees Say
The Beam: As Automation Expands, VA Commits More Errors On Veterans’ Claims
An investigation by the Washington Bureau of The Beam, an accountability newsroom at Arizona State University’s Howard Center for Investigative Journalism, found that the VA’s push to use automation more often has coincided with a surge in errors made while collecting medical records needed to process veterans’ claims. (Hogan, 11/9)
More healthcare industry developments —
Modern Healthcare: Oscar Health, AmeriHealth Caritas Expands As ACA Rivals Exit 2027
As prominent health insurance exchange carriers such as Cigna and Molina Healthcare pull back, others see an opportunity to make gains during open enrollment. Companies such as Oscar Health, AmeriHealth Caritas and Antidote Health are rolling out strategies to attract more members during this open enrollment period. Some are directing consumers to new lifestyle- and condition-focused plans. (Tepper, 11/9)
Fierce Healthcare: Aetna Sues To Challenge 2027 MA Star Ratings
Elevance Health is the latest insurer to sue the feds over its performance in the latest round of star ratings for the Medicare Advantage program. The company sued the Centers for Medicare & Medicaid Services in District of Columbia federal court on Friday, arguing that the 2027 star ratings calculations violated the Administrative Procedure Act in using 11 measures that it says were adopted unlawfully. (Minemyer, 11/9)
Modern Healthcare: Elevance Health Sues CMS Over Medicare Advantage Star Ratings
Elevance Health has joined the chorus of health insurance companies suing the federal government over the insurers’ 2027 Medicare Advantage Star Ratings. The Blue Cross and Blue Shield licensee sued the Centers for Medicare and Medicaid Services and the Health and Human Services Department in the U.S. District Court for the District of Columbia on Friday, alleging the agencies violated the Administrative Procedure Act of 1946 by failing to follow the proper rulemaking process. The company asserts this alleged misstep cost it $516 million in bonus payments, which CMS is scheduled to pay in 2028. (Tepper, 11/9)
Bloomberg: Private Credit Lenders In Talks To Fund $1.3 Billion Loan For Fullscript Deal
A group of private credit lenders is in talks to provide a $1.3 billion loan to finance L Catterton’s acquisition of healthcare platform Fullscript, after the deal was unable to drum up enough interest in the leveraged loan market. The acquisition is expected to close Tuesday, according to people with knowledge of the matter. A group of banks led by Morgan Stanley had underwritten the debt, meaning they are on the hook to fund the transaction, the people said, asking not to be identified discussing private information. The direct lending option would replace the banks’ commitments. (Seligson and Arroyo, 11/9)
Capitol News Illinois: BJC HealthCare, Aetna Extend Access For Metro East Retirees
Thousands of Illinois retirees will maintain in-network access to BJC HealthCare hospitals and providers through the end of next year after BJC and insurer Aetna reached a one-year agreement. The deal, announced Friday, Nov. 6, applies specifically to members enrolled in the TRAIL program through the end of 2027. Discussions remain ongoing between Aetna and WashU Medicine. (Ritter, 11/9)
KFF Health News: The Ultimate Adulting Task: Signing Up For Health Insurance
Not many 22-year-olds share DJ Mikunda’s enthusiasm for health insurance coverage. “You know what sounds like a good Friday night? It’s looking at health insurance,” he joked. But Mikunda has a reason to be eager. He has gone without coverage since he left home and started working in 2023. He’s now a manager at a gas station in St. Louis. (Farmer and Anthony, 11/10)
Also —
Chicago Tribune: Nurses At Edward Hospital In Naperville Vote To Unionize
Nurses at Endeavor Health Edward Hospital in Naperville have voted to unionize. Sixty-five percent of the ballots cast were in favor of the hospital’s 1,200 nurses being represented by the National Nurses Organizing Committee, an affiliate of National Nurses United, according to results announced Friday. (Stein, 11/6)
Lake County News-Sun: Waukegan Mayor Calls For Sale Of Vista Medical Center East
Amid new reports of payroll delays at Vista Medical Center East and the Illinois Department of Public Health (IDPH) no longer allowing ambulances to transport patients there, Waukegan Mayor Sam Cunningham said he has run out of patience with Vista owner American Healthcare Systems (AHS). (Sadin, 11/9)
San Francisco Chronicle: Major New Cancer Treatment Center About To Open In Oakland
Sutter Health and Stanford Medicine on Monday unveiled a new, five-story cancer center in Oakland that they hope will be a regional “one-stop shop” for outpatient oncology care in the East Bay. The center aims to accommodate the projected growth in cancer patients, which Stanford estimates will double in the next decade. Many patients must currently drive long distances to receive various components of cancer treatment. (Ho, 11/9)
On AI in healthcare —
Stat: AI Chatbots Offer Intriguing Middle Ground For Men's Mental Health
It was mid-morning when Matteo got the phone call. His wife and children were asleep in New York City, and he was at work in Trieste, Italy, a new city in a home country that felt foreign after decades abroad. He knew what his brother was going to say, on the other end of the line: Their ailing father was nearing the end. (Merelli, 11/9)
Newsweek: AI Companies Stand To Gain From Medicare Savings As Patients Fear Care Cuts
Traditional Medicare has never paid every bill on faith. Claims must meet coverage rules, and contractors review them before and after payment. But for most procedures, doctors have not had to ask permission in advance. Prior authorization has been reserved for a short list, among them certain hospital outpatient procedures, including implanted spinal stimulators, and recurring ambulance rides. On January 1, the list grew in six states, and so did the role of private technology. (Hanson, 11/9)
